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HELP -Biopsy Results

ejk

By ejk
in Dermatitis Herpetiformis

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ejk Rookie
ejk
Posted

Hi All.

I just got back from the dermatologists office. Got the stitches removed from the two punch biopsy sites I had done a couple of weeks ago. The dermo says it did not show up as DH, but something called Lichen Simplex Chronicus. So I came home and Googled that condition. First, my "lesions" don't look anything like the photos I found of LSC; they look far more like DH photos I've seen. Second, LSC doesn't seem to appear bilaterally on the body; my lesions always have a counterpart (a mirror image on the other side of my body). Like clockwork - if I get a bump/sore on my right butt cheek, in a day or two I get one in almost the exact same place on the other side. Same with bumps on my legs and shoulders.

Is there a chance that the DH is being misdiagnosed as LSC? It's not like I WANT to have DH, but I'd like to be confident in the diagnosis. The dermo just suggested using Free and Clear laundry detergent (I already do) and keeping my skin moisturized with something like Vanicream (which I already do). 

This has been going on for two years for me, and I'm starting to get really frustrated.

I'd like to hear your thoughts...

Thanks!

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squirmingitch Veteran
squirmingitch
Posted

It's possible it's being misdiagnosed. The big question is..... had you been continually eating gluten up until the time the biopsies were taken? Also, were you scratching the places where the biopsies were taken from prior to the biopsies?

 

I googled LSC & did not find anything that says it presents bilaterally. I did note that dh is listed as a differential dx of LSC but many other skin conditions are also.

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ejk Rookie
ejk
Posted
  • Author
20 hours ago, squirmingitch said:

It's possible it's being misdiagnosed. The big question is..... had you been continually eating gluten up until the time the biopsies were taken? Also, were you scratching the places where the biopsies were taken from prior to the biopsies?

 

I googled LSC & did not find anything that says it presents bilaterally. I did note that dh is listed as a differential dx of LSC but many other skin conditions are also.

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Thank you for your response! Yes, I had been eating gluten - maybe just not enough every day. The two biopsies she took:  One was directly on a lesion, but I kept insisting that DH biopsies had to be peri-lesional. She just said, "not necessarily," and then took another one right next to the one on the lesion. This skin had been previously damaged by prior lesions so was not fully intact skin. I wanted her to take one from somewhere that had skin that had not been previously damaged.

I guess I just don't have confidence in how she did the biopsies. I think I'll wait awhile and then find another dermo and get a second opinion.

Thanks for the article. I am going to read it now.

squirmingitch Veteran
squirmingitch
Posted

A gluten cracker or slice of bread per day should be enough to keep the antibodies active. If she said "not necessarily" then she has it wrong. I agree, find another derm to do the biopsy correctly. Take someone with you for the next one so they can watch. Seems like terms like to take biopsies on your back or other places where you, the patient, can not see what they're doing. The pattern the lab is looking for it extremely easily destroyed either by scratching or by the rash itself destroying the pattern in that immediate area. This is why the only good biopsy is taken on clear skin adjacent to a fresh lesion. 

Be advised that the celiac serum panel is negative 60% of the time for those of us with dh so you can't count on the celiac blood tests necessarily.

Let us know what happens please and good luck.

JaneWhoLovesRain Enthusiast
JaneWhoLovesRain
Posted

Hi - when I first saw the dermatologist for my rash he quickly looked at and said I had LSC.  I never  heard of this so went home and googled it and was rather insulted to read that it is very common among those in nursing homes and psychiatric hospitals.  And like you the description and pictures did not match what I had. (next visit I was diagnosed with psoriasis/eczema, then scabies, then after a biopsy of the lesion itself :( some strange disorder that hits 1 in 10,000 people, finally GI doctor said DH),

I just did another search on LSC and see that it is caused by chronic itching so it is very possible you (as well as many others here) could have this simply because DH is one of the itchiest skin diseases there is.  So yes, you could have LSC but the underlying issue your doctor is missing is what is causing the itch that causes you to scratch so much that it is turning skin into a leathery mess.

I just found the below picture of LSC that looks very much like my dh looked but the other pictures on the same web site look nothing like this so maybe this person has dh as well as lsc. 

Lichen%20simplex%20chronicus27.webp

 

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